Texas Violates Its Free Market Principles

I grew up in a conservative home, and if there’s one thing I learned it was the importance of the free market. This is supposedly a core conservative principle in American politics today. This week Texas conservatives have acted in direct violation of their supposed conservative and free market principles.

Texas officials lobbed another salvo in the ongoing battle to restrict or close abortion clinics in the state, announcing Monday it was cutting off Medicaid money to Planned Parenthood clinics in the wake of the controversial video of group officials discussing fetal tissue.

As I noted several weeks ago, what this means in practice is that Texas is telling Medicaid beneficiaries where they can and cannot receive care. Remember that Medicaid is not money the government hands Planned Parenthood clinics for nothing; instead, Medicaid funds are reimbursements for services rendered. It works like this: A woman who is poor enough to be on Medicaid may seek healthcare (including birth control, STD screening, etc.) at any medical clinic that takes Medicaid (some clinics do not, as Medicaid reimbursements tend to be low). The government will then reimburse that clinic for the services rendered.

How is what Texas conservatives did this week a violation of their free market principles?

First of all, while Medicaid is a government program and thus would seem to be a violation of the free market in general, conservatives tend to argue that what government programs do exist should rely as heavily on the free market as possible. This is one reason we have programs like Medicaid and Medicare, which provide private healthcare providers with reimbursements in return for services rendered to poor and elderly patients, rather than a socialized system of medicine with public health clinics and public hospitals that provide care to all comers. These programs allow the free market to continue to function, and in some sense rely on the free market.

What Texas conservatives have done this week is a direct violation of their free market principles because they are restricting the ability of the free market to do its work unencumbered with regards to Medicaid patients. Ideally, Medicaid patients are supposed to be able to choose where to go for care. This is how the free market works. Their ability to choose, the idea goes, will force healthcare providers to compete for their dollars, and thus improve the product offered. This is ostensibly why conservatives are against socialized medicine—they argue that in a free market situation consumers are in the driver seat and everyone benefits, while in a socialized situation businesses (in this case healthcare providers) have no incentive to improve or offer an effective, accessible product.

I should clarify that I don’t fully agree with conservatives on this point, but that’s irrelevant to the point I’m making here—that conservatives are violating their free market principles when they interfere in the market by artificially cutting Planned Parenthood out. Planned Parenthood has the clients it does because it has been able to compete successfully in a free market situation. Their clinics are often located conveniently, and they often offer same-day care that is far more accessible than other clinics. Free market conservatives ought to be lauding their business model. Instead, they are saying to hell with the free market.

There’s another thing here, too. I remember the debate over Obamacare well, and one of the biggest arguments conservatives made is that people should be able to choose their own doctors and healthcare providers. I’m fairly certain that people in countries with socialized medicine are generally allowed to choose their own doctors and healthcare providers too, so I’m not entirely certain why this was the big issue it was, but nonetheless, there it was—a key conservative talking point. And yet here are Texas conservatives, telling Medicaid beneficiaries that they may not in fact choose their own doctors or healthcare providers. Whatever happened to being able to choose your own doctor?

From now on, when I hear conservatives talk about the importance of the free market, or of being able to choose your own doctor and healthcare provider, my mind is going to turn to Texas conservatives’ decision to bar Planned Parenthood from receiving Medicaid funding. I can’t help it, it’s such a flagrant violation of every one of those principles!

On some level, this suggests that opposition to abortion is more important to conservatives’ than is the free market. But honestly, this isn’t even about abortion. It’s about low income women’s ability to access birth control. We know from study after study that access to affordable and effective birth control cuts the abortion rate. Further, only eight out of Planned Parenthood’ thirty-five Texas clinics offer abortion services. The rest just offer birth control. I actually grew up in a city whose Planned Parenthood clinic only offered birth control. I went to college in another such city. This is a very common thing. And yet, Texas conservatives have moved to deny Medicaid reimbursements to all Planned Parenthood clinics, not just those that provide abortion services.

The practical effect of this latest move is not to decrease the number of abortions provided—Medicaid doesn’t cover abortion to begin with—but rather to make it harder for women to access birth control:

Defunding Planned Parenthood or otherwise limiting patients’ access to its services nationally would harm women and families across the country who rely on the organization for care. And claims that other health care providers would step in to provide services in the absence of Planned Parenthood are simply unrealistic: In more than one-fifth of counties with a Planned Parenthood clinic, they are the sole provider of publicly funded family planning services.

For those with urgent medical problems, irregular work schedules or without paid sick leave, the flexibility and quick access to care offered by Planned Parenthood is critical. Planned Parenthood health centers provide service more quickly than other health centers that receive federal funding. For example, 63 percent of Planned Parenthood clinics offer same-day services, compared to 30 to 40 percent of other federally and state-funded organizations. It takes on average five to six days to get an appointment at most federally and state-funded clinics; at Planned Parenthood, it’s just 1.8 days.

Worldwide, the countries where the abortion rate is highest are not those where it is most legal but rather those where birth control is hardest to obtain. And similarly, the countries where abortion rates are lower are not those where it is illegal but rather those that offer the widest access to birth control. It is true that, in the absence of Planned Parenthood, women in the U.S. can go elsewhere for birth control services. However, any step that makes obtaining birth control more difficult will result in fewer women being able to obtain birth control services.

Birth control isn’t something you can just pick up at the pharmacy. It’s something you have to see a doctor and get a prescription for. For many low income women, this is a serious barrier. Let me give you one specific example. Getting a regular checkup at a doctor’s office generally requires making an appointment months in advance. Many disadvantaged women have work schedules that change daily or weekly. Planned Parenthood clinics in these areas often step into this gap by accepting walk-ins and same-day services. If these clinics are shuttered—a very real possibility if stripping Planned Parenthood of Medicaid reimbursements is upheld by the courts—finding birth control services will become only more difficult for these women.

I’ve noted before that if conservatives are really only interested in shutting Planned Parenthood down over their provision of abortions, and if their birth control provisions really are only collateral damage, conservatives may want to think about creating their own birth control clinics. After all, we know that birth control cuts down on the abortion rate. Interestingly, some conservatives argue that they are doing just that with Obria Medical Clinics, a pro-life healthcare alternative to Planned Parenthood. While proponents claim that these clinics offer “comprehensive medical care,” one thing is conspicuously absent—they provide neither birth control nor birth control referrals. Abortion opponents, it seems, tend to oppose more than abortion.

Let me conclude by noting that what Texas conservatives have done is illegal under federal law, and that the courts will likely intervene as they have in other states that have attempted the same thing. Federal law mandates that Medicaid beneficiaries must be allowed to obtain services from any qualified provider, and that states cannot arbitrarily limit what medical clinics or medical providers may receive Medicaid reimbursements. Texas’ latest move will be contested in courts, with the legal costs passed on to the taxpayer.

So much for fiscal conservatism.